Abstract
An investigation of the occurrence of fluorosis and caries was carried out in districts in Sweden with extremely high fluoride (F) concentrations in the drinking water. In areas with ? 10 ppm F* severe fluorosis, DEAN’S Index Grade 3 and 4, occurred on all permanent teeth and most of the primary teeth. The fluorosis was related to the F supply during the period of mineralization of the teeth. One case of “delayed” fluorosis was, however, demonstrated. In the area ? 5 ppm, 50 % of individuals had fluorosis Grade 2 and 28 % Grade 3 or 4 in the permanent teeth. Fluorosis in the primary dentition was milder, but only 20 % of the individuals were completely free from fluorosis and several cases of Grade 3 and 4 occurred in this area also. Caries frequency in the permanent teeth was higher in the ? 10 ppm area in comparison with the ? 1 ppm area. The highest DMFS values could be related to fluorosis Grade 3 and 4 in both the ? 10 ppm and ? 5 ppm areas. For the primary teeth the deft value decreased with increasing water F content and the caries frequency was not related to the degree of fluorosis. Duration of breastfeeding influenced the degree of fluorosis in areas up to ? 5 ppm in both the primary and secondary dentitions; in areas with ? 10 ppm F only the primary dentition was influenced, while the permanent teeth in these areas showed severe fluorosis even with long duration of breastfeeding. F content of saliva was, like the F content of bone and blood plasma, increased in the ? 10 ppm area. F deposition in primary teeth from the ? 10 ppm area was of the order four times that in the 1 ppm area. Pre? and post?natal F deposition is discussed with reference to analyses of F content of blood and bone, and the significance of these factors during pregnancy